- Humana (Raleigh, NC)
- …of our caring community and help us put health first** The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, ... determination of the appropriate courses of action. The Utilization Management Nurse 2 uses clinical knowledge, communication skills, and independent… more
- Cognizant (Raleigh, NC)
- …+ Educational background - Registered Nurse (RN) + 2-3 years combined clinical and/or utilization management experience with managed health care plan ... Time **Location:** Remote **About the role** As a Registered Nurse you will make an impact by performing advanced...care revenue cycle or clinic operations + Experience in utilization management to include Clinical … more
- UNC Health Care (Raleigh, NC)
- …clinical experience in a medical facility and/or comparable Utilization Management experience. **Knowledge/Skills/and Abilities Requirements:** **Job ... efficiency, and effectiveness. The Utilization Manager works collaboratively with other Clinical Care Management staff to ensure patient needs are met and… more
- Evolent (Raleigh, NC)
- …for the mission. Stay for the culture. **What You'll Be Doing:** The Clinical Review Nurse is responsible for performing precertification and prior approvals. ... physician-developed medical policies, and clinical decision-making criteria sets. The Clinical Review Nurse serves as a member advocate, expediting care… more
- Fresenius Medical Center (Garner, NC)
- **About this role:** As a Clinical Manager with Fresenius Medical Care, you will ensure that quality patient care is delivered while maintaining clinical ... or chronic kidney disease. **Training and advancement:** You will enter our Clinical Leadership Program that creates and supports a culture of continuous learning… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- …Primary Responsibilities + Adheres to regulatory regulations (eg, ERISA, HIPAA) for Case Management and self-insured clients. + Uses clinical tools for patient ... Case Management . + Determines appropriate care level and resource utilization for complex cases. + Facilitates discharge planning and evaluates alternative… more
- UNC Health Care (Chapel Hill, NC)
- …serve. The individual selected for this position will function as a Neonatal Nurse Practitioner (NNP) delivering critical care medical management in the Newborn ... by identifying and implementing processes for improvement. Consults with management in assessment, problem-solving, decision-making, and evaluating clinical… more
- CVS Health (Raleigh, NC)
- …Founded in 1993, AHH is URAC accredited in Case Management , Disease Management and Utilization Management . AHH delivers flexible medical management ... self-insured clients. + Application and/or interpretation of applicable criteria and clinical guidelines, standardized care management plans, polices, procedures… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role Brighton Health Plan Solutions (BHPS) provides Utilization Review/Medical and Case Management services for Group Health and Workers' Compensation ... and other Casualty clients. The Workers' Compensation Intake Nurse reaches out to injured workers to determine the...clinical environment required. + Previous workers' compensation case management experience a plus. + Strong skills in medical… more
- Evolent (Raleigh, NC)
- …team focusing on appeals and post-determination requests. We maintain the principles of utilization management by adhering to Evolent and Client policies and ... accomplishments. **What You Will Be Doing:** + Practices and maintains the principles of utilization management and appeals management by adhering to company… more
- Granville Medical Center (Oxford, NC)
- Emergency Department Nurse (LPN/RN) Location: Granville Health System, Oxford NC About Granville Health System: For over a century, Granville Health System has been ... a group of patients, providing care through the continued utilization of the nursing process in collaboration with other...the State of North Carolina as a Licensed Practical Nurse . BLS certification is required within 6 months of… more
- Granville Health System (Oxford, NC)
- Emergency Department Nurse (LPN/RN) # Location: Granville Health System, Oxford NC # About Granville Health System: For over a century, Granville Health System has ... a group of patients, providing care through the continued utilization of the nursing process in collaboration with other...the State of North Carolina as a Licensed Practical Nurse . BLS certification is required within 6 months of… more
- CenterWell (Youngsville, NC)
- …requires you to sit on-site at our Youngsville, NC branch location.** The ** Clinical Manager** coordinates and oversees all direct care patient services provided by ... clinical personnel. + Develops, plans, implements, analyzes, and organizes clinical operations for a specific location managed. + Conducts/delegates the… more
- CenterWell (Raleigh, NC)
- …with scheduled hours spanning Friday afternoon through Monday afternoon to support clinical operations across multiple branch locations.** The **Weekend Regional RN ... Clinical Manager** provides weekend oversight and clinical ... documentation in addition to feedback and recommendations by Utilization Review staff. Upon completion of the assessment, creates… more
- Deloitte (Raleigh, NC)
- … registered nurse , physician, physician assistant, case manager, clinical documentation specialist, utilization review, informatics RN, Quality, DRG ... and informal education of physicians, CDI team, health information management and other clinical staff + Develop...medical degree, or physician assistant required + Current Registered Nurse (RN) license required + Certified Clinical … more
- UNC Health Care (Chapel Hill, NC)
- …and Care Management Assistants. + Candidate must be a **Registered Nurse (RN)** or **Licensed Clinical Social Worker (LCSW/LCSWA)** + Preference given ... for designated Clinical Care Management Department team(s). Provides management direction to Case Managers, Utilization Managers, Clinical Social… more
- Brighton Health Plan Solutions, LLC (Chapel Hill, NC)
- About The Role MagnaCare provides Utilization Review/ Case Management / Medical Management /Claims Review services to its clients. Care Coordinators facilitate ... care management and utilization review by performing data...accordance with departmental workflows, policies and procedures. + Assist Nurse Case Reviewers with non- clinical issues tasks… more
- UNC Health Care (Chapel Hill, NC)
- …through the integrating and functions of point of entry case management , utilization review, and effective patient flow activities. Responsibilities: ... implement a hospital wide capacity management strategy. 3. Logistics Management - Collaborate with house supervisors and clinical admitting decision makers… more
- Oracle (Raleigh, NC)
- …of analysts providing support for operationally required changes and enhancements to clinical applications, and aa group of analysts leading projects that will ... These include, but are not limited to, multiple Essential Clinical Dataset (ECD) alignments, Critical Care workflow implementation, Multi-Disciplinary Rounding,… more
- Highmark Health (Raleigh, NC)
- …and education or if necessary involve Special Investigation Unit or the Utilization Management area. **ESSENTIAL RESPONSIBILITIES** + Implement the pre-payment ... data to assure appropriate level of payment and resource utilization . It is also used to identify issues which...- 5 years of related, progressive experience in a clinical setting **Preferred** + 1-3 years of experience in… more